National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Tuberculosis in the United States

1993–2018*

National Tuberculosis Surveillance System

Division of Tuberculosis Elimination

*Updated as of June 6, 2019
Reported Tuberculosis (TB) Cases and Rates 

United States, 1993–2018
Total TB Case Rates and

Annual Percent Change in Rate, 2010–2018 

-6.1

-4.4 -2.4 +0.9 -3.7 -2.4 -1.3

-6.1

Year

Cases per 100,000 population
Reported Tuberculosis (TB) Deaths* and Rates 

United States, 1993–2017

*National Vital Statistics System Multiple Causes of Death (accessed from CDC Wonder)
Percentage of TB Cases by State, United States, 2018

DC, District of Columbia

DC

12.5

6.5

23.2

8.3
TB Incidence Rate (per 100,000 persons)

5.3

8.5

3.9

NYC (6.7)

D.C. (5.1)

8.4
Map of U.S.-Affiliated Pacific Islands and Hawaii

by TB Case Rates*, 2018

Northern 

Mariana Islands

90.4

American 

Samoa

2.0

Guam 41.7

Palau

94.4

Hawaii

8.4

*Cases per 100,000 population
TB Cases and Rates Among U.S.-Born versus 

Non-U.S.–Born Persons, United States, 1993–2018

Cases per 100,000 Population
Countries of Birth Among Non-U.S.–Born Persons 

Reported with TB, United States, 2018*

*Percentages are rounded.
TB Rates for Top 10 Countries of Birth*

United States, 2014–2018

*The top 10 countries were selected based on their ranked 5-year rate of TB cases by country of birth in the United States. This list of top countries also includes the regions of Eastern Africa and 

Other Africa. 

† The Eastern Africa region consists of British Indian Ocean Territory, Burundi, Comoros, Djibouti, Europa Island, Glorioso Islands, Juan De Nova Island, Madagascar, Malawi, Mayotte, 

Mozambique, Reunion, Rwanda, Mauritius, Seychelles, Tromelin Island, and South Sudan. Rwanda and South Sudan were removed from the Eastern Africa region in 2017.

§ The Other Africa region consists of Angola, Botswana, Central African Republic, Chad, Equatorial Guinea, Gabon, Lesotho, Namibia, Sao Tome & Principe, and Swaziland.
Percentage of Non-US–Born TB Cases

by Time in the United States at Diagnosis, 2018

Percentage of TB Cases

Time in the United States
Reported TB Cases by Race/Ethnicity,*

United States, 2010–2018

* All races are non-Hispanic; multiple race indicates two or more races reported for a person, but does not include persons of Hispanic/Latino origin. Total No. of Cases
TB Case Rates by Race/Ethnicity,* 

United States, 2010–2018

* All races are non-Hispanic; multiple race indicates two or more races reported for a person, but does not include persons of Hispanic/Latino origin.

† Asian race category reporting includes Pacific Islander from 1993–2002; Native Hawaiian/Other Pacific Islander race first reported separately in 2003.

¶ Multiple race rates first reported in 2003.

Cases per 100,000 population
Reported TB Cases by Origin and Race/Ethnicity*, 

United States, 2018†

Non-U.S.-born persons § U.S.–born persons

* All races are non-Hispanic; multiple race indicates two or more races reported for a person, but does not include persons of Hispanic/Latino origin.

† Percentages are rounded.

§ American Indian/Alaska Native accounted for <1% of cases among non-U.S.–born persons and are not shown.

Native Hawaiian/

Pacific Islander

American Indian/

Alaska Native

Multiple Race

White

Hispanic/Latino

Black/African American

Asian
Reported TB Cases by Age Group, 

United States, 1993–2018

Total No. of Cases
TB Case Rates by Age Group, 

United States, 1993–2018

Cases per 100,000 population

Year
Distribution of Sex by Age Group, 

United States, 2018

Males Females

<5 yrs

5–14 yrs

15– 4 yrs

25–44 yrs

45–64 yrs

65+ yrs

Age Group
Pediatric TB Cases by Age Group, 1993–2018
Number of U.S. Pediatric TB Cases among U.S.-Born 

and Non-U.S.–Born* Children, 1993–2018

*Non-U.S.–born refers to persons born outside the United States or its territories or not born to a U.S. citizen
Number of U.S. Pediatric TB Cases among U.S.-Born 

Children by Parent/Guardian Status, 2010–2018

*At least one parent/guardian was non-U.S.–born
Number of U.S. TB Cases by Case Verification Criteria, 

1993–2018
U.S. TB Cases by Site of Disease, 2018

*Any extrapulmonary involvement which includes cases that are extrapulmonary only and both pulmonary and extrapulmonary.

Patients may have more than one disease site but are counted in mutually exclusive categories for surveillance purposes. 

Note: Percentages are rounded.
Percentage of Tuberculosis Cases*, by Initial Drug 

Regimen, United States, 1993–2018

*Alive at diagnosis

†

Isoniazid, Rifampin, Pyrazinamide and Ethambutol
Mode of Treatment Administration Among Persons 

Reported with TB, United States, 1993–2016*

Percentage of All

Treatment Modes

†

Year

DOT, directly observed therapy; SA, self-administered therapy.

* Data available through 2016 only.

† Percentage of total cases among persons alive at diagnosis, with an initial regimen of one or more drugs prescribed and excluding cases with unknown 

mode of treatment administration.
Completion of TB Therapy,

United States, 1993–2016*

*Data available through 2016 only.

Note: Includes persons eligible to complete therapy within one year of diagnosis.

2016
Isoniazid Resistance Among U.S.-Born versus NonU.S.–Born Persons, United States, 1993–2018
Cases of MDR TB* by History of TB, United States, 

1993–2018

* Multidrug-resistant TB (MDR TB) is defined as resistance to at least isoniazid and rifampin.
HIV Coinfection by Age Among Persons 

Reported with TB, United States, 2011–2018
Reported TB Case Percentages* by Risk Factor, United 

States, 2018

Non-HIV 

immunosuppression

Contact to Infectious TB

Diabetes Mellitus

Contact to Infectious TB Diabetes Mellitus

Comparison of Selected Risk 

Most Common Risk Factors Reported Among TB Patients Factors by Origin of Birth

*Percentages are rounded
*Correctional facilities include federal prisons, state prisons, local jails, juvenile correctional facilities, other correctional facilities, or unknown type of 

correctional facility.

TB Cases among Residents of Correctional Facilities Ages ≥15, 

1993–2018*
TB Cases among Residents of Correctional Facilities 

Ages ≥15 by Type of Facility, 1993–2018

*Includes Immigration and Customs Enforcement (ICE) detention centers, tribal jails operated by Indian reservations, police lockups (temporary 

holding facilities for person who have not been formally charged in court), military stockades and jails, or federal park facilities
TB Cases Ages ≥15 with Other Selected Risk Factors, 

2018

Risk Factor
Substance Misuse Among TB Patients ≥15 years, 

United States, 2018 
Primary Occupation Among U.S. TB Patients 

Age ≥15 years, 2018 

Percentage of TB Cases

Occupation
TB Cases by Reason Therapy Stopped, 2016*

*Data available through 2016 only.

Outcomes for patients that did not 

complete treatment
Deaths Attributed to TB Disease or TB Treatment, 2016*

9 of every 100 TB patients diagnosed in 2016 died 

before diagnosis or during treatment

More than 3 of the 9 

deaths were attributed to 

TB disease or TB treatment 

*Data available through 2016 only.
Sputum Culture Conversion, United 

States, 2016
National Tuberculosis Genotyping Surveillance 

Coverage* by Year: United States†, 2004–2018

* The proportion of positive cultures with at least one genotyped isolate.

†

Includes 50 states and the District of Columbia.

§ For the year 2020, the national goal for TB genotyping surveillance coverage will change to 100%.

National Goal, 

94%§
Definition for Tuberculosis Genotyping

in the United States

Initial 12-locus MIRU-VNTR1: 

223325173533

Spoligotype: 

000000000003771

PCRType:

PCR00002

Additional 12-locus 

MIRU-VNTR (MIRU2): 

4445344234282

+

GENType:

G00010

Sequentially assigned for 

each unique spoligotype 

and initial 12-locus MIRUVNTR combination

Sequentially assigned for each 

unique spoligotype and 24-locus 

MIRU-VNTR combination

1 Mycobacterial interspersed repetitive unit–variable number tandem repeat.

2 The complete set of 24 loci is referred to as 24-locus MIRU-VNTR and is used for GENType designation for genotype in the United States.
Number of County-based Tuberculosis Genotype 

Clusters* by Cluster Size, United States, 2016–2018

*Genotype cluster is defined as two or more cases with matching spoligotype and 24-locus MIRU-VNTR (GENType) within a county during the 

specified 3-year time period.
Tuberculosis Genotype Clusters by TB GIMS* Alert 

Levels†, United States, 2016–2018

*Tuberculosis Genotyping Information Management System

†Alert level is determined by the log likelihood ratio statistic (LLR) for a given cluster, identifying higher than expected geospatial concentrations for 

a TB genotype cluster in a specific county, compared to the national distribution of that genotype; TB GIMS generates alert level notifications based 

on this statistic: “No alert” is indicated if LLR is between 0 – <5, “medium” is for LLR of 5 – <10 and “high” alert is for clusters with LLR ≥ 10.
Genotyped Tuberculosis Cases Estimated to be Attributed 

to Recent Transmission, United States, 2017–2018

Recent Transmission*

12.6% (n=1,712)

Not Recent 

Transmission§

(n=11,889)

8.3% 

(n=1,123)

Limited Recent Transmission 4.3% (n=589)

Extensive Recent Transmission†

* A TB case is designated as attributed to recent transmission if a plausible source case can be identified in a person who i) has the same M. tuberculosis genotype, ii) 

has an infectious form of TB disease, iii) resides within 10 miles of the TB case, iv) is 10 years of age or older, and v) was diagnosed within 2 years before the TB case.

† A TB case is designated as attributed to extensive recent transmission when the criteria above for recent transmission are met, and furthermore the case belongs to 

a plausible transmission chain of six or more cases. Otherwise, the case is designated as attributed to limited recent transmission.

§ Cases not attributed to recent transmission may be misclassified in children <5 years old or indeterminate in persons with a recent U.S. arrival due to limitations of 

the plausible-source case method. 
Genotyped Cases Estimated to be Attributed to Limited and 

Extensive Recent Transmission, United States, 2015–2018

n=1,712

* A TB case is designated as attributed to recent transmission if a plausible source case can be identified in a person who i) has the same M. tuberculosis genotype, ii) has an infectious 

form of TB disease, iii) resides within 10 miles of the TB case, iv) is 10 years of age or older, and v) was diagnosed within 2 years before the TB case.

† A TB case is designated as attributed to extensive recent transmission when the criteria above for recent transmission are met, and furthermore the case belongs to a plausible 

transmission chain of six or more cases. Otherwise, the case is designated as attributed to limited recent transmission.
Percentages of Tuberculosis Cases Estimated to be Attributed and Not 

Attributed to Recent Transmission, by Origin of Birth*, 2017–2018

* Cases with unknown origin of birth not shown (n=21).

† A TB case is designated as attributed to recent transmission if a plausible source case can be identified in a person who i) has the same M. tuberculosis

genotype, ii) has an infectious form of TB disease, iii) resides within 10 miles of the TB case, iv) is 10 years of age or older, and v) was diagnosed within 2 years 

before the TB case.

§ Cases not attributed to recent transmission may be misclassified in children <5 years old or indeterminate in persons with a recent U.S. arrival due to 

limitations of the plausible-source case method. 

Non-U.S.–born U.S.-born

†

§

7.6%

(n=739)
The findings and conclusions in this report are those of the authors and do not necessarily 

represent the official position of the Centers for Disease Control and Prevention.

Division of Tuberculosis Elimination 

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Centers for Disease Control and Prevention 

1600 Clifton Road NE

US 12-4

Atlanta, GA 30329

Phone: 404-639-8120

Internet Address: http://www.cdc.gov/tb/